The Title Is About The Power

When I was young and worked at Sticksville General Emerg, we had exactly one dental surgeon on call. I secretly called him Dr. Fabulous, because in his esteemed and respected opinion, he was fabulous. He was fabulously good-looking, and lived in a fabulous house with fabulous wife and children; his practice was fabulous, and of course, his ego was fabulously huge.

As I’ve mentioned before, Sticksville Gen was somewhat reactionary in attitude: the physicians were all men and the real leaders and heroes, and the nurses followed them like meek lost puppies. We had one nurse — Suzanne — however, who didn’t quite fit the mold: she was, truth be told, dangerously mouthy.

One day, Dr. Fabulous made his triumphal entrance, all pomp and self-regard, into the emergency department to look at the smashed mandible of an 18 year-old hockey player.

“Jim,” said Suzanne, “Your patient is in Minor Trauma.”

Dr. Fabulous screwed up his eyes and made a great show of looking at Suzanne’s name tag.

“Suzie,” he said, “You will please address me as Dr. Fabulous!”

Without missing a beat Suzanne screwed up her eyes and looked at Dr. Fabulous’s name tag.

“In that case, Jimmy,” she said, “You may call me Nurse Assertive or Mrs. Assertive. Only the people I like get to call me Suzie!”

Shirato, a nurse practitioner, just got her doctor of nursing practice degree at Thomas Jefferson University.

[snip]

Most newly graduating physical therapists now have doctorates, too. Pharmacists and psychologists already made that move. Audiologists, physician assistants, and occupational therapists can also get doctorates.

As nonphysicians with doctorates proliferate, the potential for confusion has grown, and physicians aren’t happy about it. A 2008 survey by the American Medical Association found that 38 percent of patients believed that nurses with doctorates were medical doctors.

The American Medial Association has produced model “truth in advertising” legislation that requires health professionals, including physicians, to wear badges that clearly spell out their credentials.

Yeah, well, yawn. Just do normal practice and identify yourself when you meet the patient. In any case, I’ve come around to the opinion that titles of any sort are antiquated expressions of professional authority. Physicians acquired the title “doctor” — and remember it was originally, and still is, an academic title — over the course of the 18th Century to establish their credentials on par with the traditional professions (and gain entrance to the middle-class). They then spent a good part 19th Century trying to deny the same title to surgeons who were, in their opinion, “mere barbers.”

Titles, in short, are about establishing status and power. Why else worry about them? They are utterly irrelevant to actual patient care and one’s ability to do the job. Insisting on their use can create an atmosphere of professional intimidation that suppresses the free exchange of information. Health care professionals expressing power over patients is definitely not a good way to create therapeutic relationships. Implicitly saying (or believing) the title makes you a better person or supplies you with definitive or superior knowledge about patient care is dangerous as well as destructive to collaborative relationships with other health care professionals. In the end, it results in bad care of our patients, and of each other.

Some physicians really resent the loss of power. Don’t believe me? Check out why the defensiveness of this physician.

James Goodyear, a Lansdale, Pa., general surgeon and president of the Pennsylvania Medical Society, said health care workers who are not physicians should immediately tell patients what they do.

“I am a physician. They are not,” he said. “They trained for hundreds of hours. We trained for thousands of hours.”

And, he said, physicians should still be in charge. “We think that those in the allied health fields that get a doctorate such as in nursing are a very, very important component of a physician-directed … team,” he said. [Emphasis mine.]

Not about power and status? Fer sure. When this guy says, “I am physician” you can almost hear the sub-vocal “I am God”.

I’m surprised by this….well, not really surprised. I work in OB, where most of us are on the first name basis. Nurses call docs by their first names and vice versa. I know of a few of the docs who introduce themselves to patients by their first and last name – leaving out the “doctor” part. “Hello. I’m John Smith.”

There was a move several years ago by the Alberta Medical Association to have the province ban anyone who wasn’t a physician from calling themselves doctor. Naturally the PhD’s of the province, in all fields not just medicine, had something to say about that. The physicians quietly dropped it when it was pointed out that doctor comes from the Latin for teacher and not physician an as such it was they who should drop the title.

My niece and I were talking about this very thing last night. She is just finishing up her PhD and she brought up the very subject: discrepency of MDs needing to be called “Doctor” and how titles are used for superiority over everyone else… interesting and timely. Personally, I most often called MDs I worked with by their last name only….I don’t know why. I just did. No one seemed to mind.

I had a real nasty run in with a vet who walk into the nursing ststion on the floor I work on. He proclaim for everyone in ear shot that “I’m doctor X and I want the chart of Pt Y” (pt Y was his step-son). Things got really ulgy really fast When I deard to point that as a vet he had no business being in the nursing ststion and even less attempting to at a pt’s chart. The end result was the hospital now has ID badges that clearly state the wearers status.

However, some Dr.s do have family members who are also physicians, and they may be very proud of this legacy. Likewise for Nurses, and other professionals— teachers, Psychologists etc. Still, this does not give anyone the right to abuse their power.

Another thought I have is that people who don’t have a degree such as a BSc, BA, BFA, BArch., and talk to people who are doing their Master’s, will often assume that they have done more research work because they have worked in a job and have real-world research experience.

This is also not fair, as a Master’s student definitely has more education and depth of practice than an undergrad who worked at a summer job entering data to MSexcel. Not to minimize, but this happens all the time to people I know and it can turn very ugly very fast, where someone with less educational experience literally sabotages and steals academic ideas without acknowledging credentials of their research partners. It makes you feel like a wuss and a child stuck in a corner.

I think it’s valid to bring this up, but there are many factors for why people behave the way they do. In the end, it’s not worth your time to fight with big headed antisocial perfectionist-liars. They’ll beat you with their angry stick, or whatever that saying is…you know?

In all honesty, as a patient I’d want to know if the person helping me is a medical doctor or a nurse or any other type of provider. Having IDs would be a good idea to help patients know who is treating them.

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